Provider Demographics
NPI:1043862048
Name:SCARBOROUGH, SHAY
Entity Type:Individual
Prefix:
First Name:SHAY
Middle Name:
Last Name:SCARBOROUGH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6754 FM 1087
Mailing Address - Street 2:
Mailing Address - City:GARRISON
Mailing Address - State:TX
Mailing Address - Zip Code:75946-5578
Mailing Address - Country:US
Mailing Address - Phone:832-314-3735
Mailing Address - Fax:
Practice Address - Street 1:6754 FM 1087
Practice Address - Street 2:
Practice Address - City:GARRISON
Practice Address - State:TX
Practice Address - Zip Code:75946-5578
Practice Address - Country:US
Practice Address - Phone:832-314-3735
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-10
Last Update Date:2019-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2060393225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2060393OtherTEXAS BOARD OF PT EXAMINERS